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Tobacco use among pregnant women in North Carolina : predictors of smoking cessation during pregnancy : results from the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS), 1997-2001

Tobacco use among pregnant women in North Carolina : predictors of smoking cessation during pregnancy : results from the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS), 1997-2001 - Page 2

SCHS Study No. 138 – N. C. PRAMS 2 State Center for Health Statistics
Introduction
The public health community has made intensive efforts
to educate the general public on the hazards of cigarette
smoking. These hazards are exceedingly detrimental
during pregnancy. Previous studies have found that
women who smoke during pregnancy are at greater risk
for preterm labor and delivery, spontaneous abortion,
reduced infant birth weight, and neonatal and fetal
deaths. 1- 6 In addition, Sudden Infant Death Syndrome
( SIDS) and respiratory illnesses in children have been
associated with maternal smoking after delivery and
infant exposure to second- hand cigarette smoke. 7,8
Smoking is recognized as the number one preventable risk
factor associated with adverse birth outcomes in the United
States. 7 In fact, the Surgeon General’s 2001 Report on
Women and Smoking stated that by eliminating maternal
smoking during pregnancy, we might reduce infant
mortality by 10 percent, low birth weight births by 20
percent, and preterm deliveries by eight percent in this
country. 7 This report from the Surgeon General also found
that infants born to mothers who quit smoking during the
first trimester are comparable to infants of non- smoking
mothers by weight and body measurements.
Recognizing the hazardous effects of smoking on unborn
babies, many expectant mothers quit smoking during
pregnancy. In North Carolina, smoking prevalence
among reproductive age women is approximately 25
percent9 and half of those quit smoking during pregnancy.
A number of previous studies have explored correlates
of persistent smoking during pregnancy. A clinical study
with a small number of pregnant women reported that
smokers were more likely to engage in negative health
behaviors compared to those who quit or never smoked. 10
Another clinical study of 200 pregnant women in the UK
found that there were no differences among smokers, ex-smokers,
and women who never smoked in the level of
knowledge about the dangers of maternal smoking, and
that partner smoking habits had a significant effect on
maternal smoking. 11 Studies in England and Denmark
found that a higher level of smoking before pregnancy,
coffee consumption, partner smoking, a higher number
of previous live births, and lower education were
associated with smoking during pregnancy. 12,13 A study
using the 1998 National Health Interview Survey ( NHIS)
supplement on Pregnancy and Smoking found that, when
comparing women who successfully quit and women
who tried to quit and failed, nicotine dependence ( i. e.,
longer duration of previous smoking) interconnected
with age ( older women are less likely to quit), was
associated with lower success in smoking cessation. 14
Pregnant women who quit tend to have less risky
demographic profiles compared to women who smoke
during pregnancy. They are more likely to have graduated
from high school and less likely to be a single parent. 15,16
While these and other previous studies tend to focus on
the sociodemographic and economic differences between
women who quit smoking during pregnancy and
persistent smokers, less is known about the social and
behavioral differences between women who quit and
those who continue to smoke, as well as differences in
birth outcomes. Moreover, the sample sizes of previous
population- based surveys and clinic- based studies are
often too small for multivariate analyses. The North
Carolina Pregnancy Risk Assessment Monitoring System
( PRAMS) collects data on various maternal behaviors
before, during, and after pregnancy using a representative
sample of North Carolina mothers with a recent live birth.
In this study, by using North Carolina PRAMS data, we
identify maternal sociodemographic factors as well as
maternal behaviors and birth outcomes associated with
smoking behavior during pregnancy among women who
smoked before pregnancy. We also look at the intensity
of smoking among women who do not quit smoking
during pregnancy compared to the intensity of smoking
before pregnancy. The information presented in this study
may be used to evaluate health programs and plan future
efforts to reduce smoking among pregnant women in
North Carolina.
Methods
The Sample
The sample used in this study was obtained from the
North Carolina Pregnancy Risk Assessment Monitoring
System ( PRAMS). PRAMS was developed by the
Centers for Disease Control and Prevention in 1987 to
provide state- specific, population- based surveillance of
selected maternal behaviors and conditions that occur
before, during, and after pregnancy. PRAMS is a random,
stratified, monthly mail/ telephone survey of North
Carolina women who recently delivered a live- born
infant. Each month around 200 women are selected from
the Provisional Live Birth File and are interviewed

SCHS Study No. 138 – N. C. PRAMS 2 State Center for Health Statistics
Introduction
The public health community has made intensive efforts
to educate the general public on the hazards of cigarette
smoking. These hazards are exceedingly detrimental
during pregnancy. Previous studies have found that
women who smoke during pregnancy are at greater risk
for preterm labor and delivery, spontaneous abortion,
reduced infant birth weight, and neonatal and fetal
deaths. 1- 6 In addition, Sudden Infant Death Syndrome
( SIDS) and respiratory illnesses in children have been
associated with maternal smoking after delivery and
infant exposure to second- hand cigarette smoke. 7,8
Smoking is recognized as the number one preventable risk
factor associated with adverse birth outcomes in the United
States. 7 In fact, the Surgeon General’s 2001 Report on
Women and Smoking stated that by eliminating maternal
smoking during pregnancy, we might reduce infant
mortality by 10 percent, low birth weight births by 20
percent, and preterm deliveries by eight percent in this
country. 7 This report from the Surgeon General also found
that infants born to mothers who quit smoking during the
first trimester are comparable to infants of non- smoking
mothers by weight and body measurements.
Recognizing the hazardous effects of smoking on unborn
babies, many expectant mothers quit smoking during
pregnancy. In North Carolina, smoking prevalence
among reproductive age women is approximately 25
percent9 and half of those quit smoking during pregnancy.
A number of previous studies have explored correlates
of persistent smoking during pregnancy. A clinical study
with a small number of pregnant women reported that
smokers were more likely to engage in negative health
behaviors compared to those who quit or never smoked. 10
Another clinical study of 200 pregnant women in the UK
found that there were no differences among smokers, ex-smokers,
and women who never smoked in the level of
knowledge about the dangers of maternal smoking, and
that partner smoking habits had a significant effect on
maternal smoking. 11 Studies in England and Denmark
found that a higher level of smoking before pregnancy,
coffee consumption, partner smoking, a higher number
of previous live births, and lower education were
associated with smoking during pregnancy. 12,13 A study
using the 1998 National Health Interview Survey ( NHIS)
supplement on Pregnancy and Smoking found that, when
comparing women who successfully quit and women
who tried to quit and failed, nicotine dependence ( i. e.,
longer duration of previous smoking) interconnected
with age ( older women are less likely to quit), was
associated with lower success in smoking cessation. 14
Pregnant women who quit tend to have less risky
demographic profiles compared to women who smoke
during pregnancy. They are more likely to have graduated
from high school and less likely to be a single parent. 15,16
While these and other previous studies tend to focus on
the sociodemographic and economic differences between
women who quit smoking during pregnancy and
persistent smokers, less is known about the social and
behavioral differences between women who quit and
those who continue to smoke, as well as differences in
birth outcomes. Moreover, the sample sizes of previous
population- based surveys and clinic- based studies are
often too small for multivariate analyses. The North
Carolina Pregnancy Risk Assessment Monitoring System
( PRAMS) collects data on various maternal behaviors
before, during, and after pregnancy using a representative
sample of North Carolina mothers with a recent live birth.
In this study, by using North Carolina PRAMS data, we
identify maternal sociodemographic factors as well as
maternal behaviors and birth outcomes associated with
smoking behavior during pregnancy among women who
smoked before pregnancy. We also look at the intensity
of smoking among women who do not quit smoking
during pregnancy compared to the intensity of smoking
before pregnancy. The information presented in this study
may be used to evaluate health programs and plan future
efforts to reduce smoking among pregnant women in
North Carolina.
Methods
The Sample
The sample used in this study was obtained from the
North Carolina Pregnancy Risk Assessment Monitoring
System ( PRAMS). PRAMS was developed by the
Centers for Disease Control and Prevention in 1987 to
provide state- specific, population- based surveillance of
selected maternal behaviors and conditions that occur
before, during, and after pregnancy. PRAMS is a random,
stratified, monthly mail/ telephone survey of North
Carolina women who recently delivered a live- born
infant. Each month around 200 women are selected from
the Provisional Live Birth File and are interviewed